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Dr. G., Psychologist

Category: Mental Health

Satisfied Customers: 1467

Experience: Licensed Psychologist.

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Hello

I went through a 6 month assessment for schizophrenia with a psychiatrist.

At the end of the assessment, the psychiatrist diagnosed me with having schizophrenia, but his evaluation/diagnostic report shows no evidence of diagnostic criteria symptoms to support his diagnosis.

This report was sent to my GP and an electronic entry of schizophrenia was made on my file.

I complained about the diagnosis on two occassions, but despite this my GP never questioned the psychiatrist's report or made me aware that there was discrepancy in the diagnosis made because the report showed no evidence of diagnostic criteria symptoms.

My GP is trained in initially diagnosing schizophrenia based on history, symptoms and evaluation.

Therefore, if the psychiatrist's report does not show any diagnostic criteria symptoms to support his diagnosis then surely my GP should have recognised this, made me aware and questioned the report. Is this right?

It is right that you questioned it. I recently read a report from another agency that diagnosed with PTSD but did not have any information supporting that diagnosis. If you feel comfortable, you can talk to the psychiatrist and have that person explain to you their rationale for the diagnosis. If you don't feel comfortable then you can get an evaluation done elsewhere. But if I am you, I would want to know why I am diagnosed with schizophrenia.

Thank you. I am in the process of questioning why I was diagnosed with schizophrenia. I have put in a letter of complaint to the hospital asking the following question;

1. How was the diagnosis reached?

However, this question was not answered. I subsequently sent an additional four letters to the hospital asking that my outstanding question above is answered, but despite these letters I still have not recieved an answer - and it's been 4 months now. I have also requested a meeting to discuss how the diagnosis was reached.

So I am in the process; but I want to know about my GP and what he should have done when he got the report because he made an electronic entry of schizophrenia on my file when he should have known it was incorrect because of lack of evidence.

Therefore, would it be valid for me to ask my GP the following question?;

"You were made aware (through Dr Price's report) that there was no evidence to support his diagnosis. Why was I not made aware of this and the report questioned?"

Absolutely it is a fair question. My guess is the GP relied on the psychiatrist to make a diagnosis, which often times is the case. And also is the case is that the physician will just put down whatever the diagnosis is that the psychiatrist made. I know you might be upset with this but I wouldn't jump to conclusions just yet. Meaning, go in there and talk calmly and try to get clarification before finger pointing. I say this so that you don't look like a crazy person causing trouble. But you already know that.

During an appointment with my GP in November 2009, I told him my anxiety condition is getting worse [essentially due to harassment] and I would like to see someone about it. He told me "you could be schizophrenic." My medical file contains information on depression, tinnitus and social anxiety. So there is no reason to suggest schizophrenia.

Therefore, would it be valid for me to ask my GP the following question?;

"During an appointment in November 2009, you told me I could be schizophrenic. What was your reason for saying I could be schizophrenic?"

Following our dialogue I note your statement "I am curious now too about this diagnosis."

As mentioned in my second post, I was in the process of asking "how the diagnosis was reached" and arranged a meeting with the Trust to discuss this; which I attended on 12 September. I recieved a written response from the Trust on 19 October.

To bring you fully into the picture I paste the initial diagnosis report, my letter requesting a meeting to discuss the diagnosis and the Trust's response post meeting date.

I would appreciate it if you could review the report/letter and let me know if they are justified.

The initial diagnosis report (dated 21 April 2010) is as follows;

I reviewed Mr Stanmore in my clinic at the Donold Winnicott Centre on 25thAugust 2010, although he was thirty minutes late. Fortunately, my precedingpatient failed to attend so I was able to assess him myself.

You will be aware that he had previously been assessed by Dr Holland and hashad an assessment for CBT. Mr Stanmore informed me that he had beenoffered a course of CBT, but had rejected this because he does not believehe is unwell or would indeed benefit from this intervention. He continues toharbour delusional beliefs of persecution relating to the police. He believeshe is being monitored by them for reasons he cannot understand and hebelieves that this monitoring has extended to his neighbours and generalcommunity. He feels watched and looked upon in a peculiar way, notconsistent with people's normal behaviour. He believes that shop keepershave been informed about him by the police and observe him from adistance attending the shop and give him close scrutiny while he is in theshop, such as looking at his hands in a way which distresses him. He connotaccount for this and informs me that his family and friends do not believe him,although he is unwllling to accept a psychological explanation such aspsychosis.

It is my belief that Mr Stanmore is clearly suffering from a Paranoid Psychosis,which is untreated. His symptoms may be consistent with a diagnosis ofPersistent Delusional Disorder or Paranoid Schizophrenia. I have no doubt thathe would benefit from a trial of treatment with an antipsychotic, although heis not willing to accept this. You will be aware that he also suffers fromsignificant symptoms of anxiety, possibly as a result of his psychoticphenomena and I understand that he has been considered appropriate forCognitive Behavioural Therapy, but would prefer not to engage either.

He does not believe that we at the Mental Health Team are involved in theconspiracy, although he informed me that you have told him he may haveSchizophrenia. I myself told him today that I think that you may be right, but he is unwilling to accept this possibility.

I asked him if he wished to followed up in the clinic and he said that he wouldnot; so reluctantly l will discharge him from care. Although he is distressed byhis symptomotology the risks are low and he does not feel the need to actupon his beliefs in a way which would cause concern. There are no groundsfor compulsory treating him under The Mental Health Act, although I haveasked him to consider what both you and I have said to him and I wouldaccept his re-referral should he be willing to engage or should circumstanceschange, such that we would be able to act.

Consultant Psychiatrist

My letter requesting a local resolution meeting (dated 25 July 2011) is as follows;

Dear Claire

Local Resolution Meeting

Following my letter of 27 June, which I note was not adequately addressed; I write to request a local resolution meeting with Dr Sherrin as per Dr Curran's letter of 13 July to discuss my outstanding concerns which are outlined below.

How was the diagnosis reached?

On what grounds does the diagnosis remain?

The aim of this meeting is to get oral reasons to the above questions as I do not believe my outstanding concern regarding Dr Barnett’s diagnosis has been adequately addressed.

I believe the hospital/psychiatrist must provide both oral and written reasons at the time of the decision of mental health assessments. I do not believe Dr Barnett provided any reasons for his diagnosis both at the assessment and in his report dated 21 April 2010. [Please note, I realised after sending this letter that my police complaint could be used as a reason for the diagnosis; although I was coerced into talking about it and I believe the Trust were aware of what was going on. And, I am not sure if my complaint is adequate to diagnose me with paranoid schizophrenia.]

I am also requesting the reasons for Dr Barnett’s diagnosis in writing post meeting date.

I understand that the Trust may need to contact me prior to the meeting and confirm I have no objections to this. My contact number is XXXXX(NNN) NNN-NNNN

I would like to make it clear that this meeting is not to discuss inaccurate or false statements written about me throughout the assessment. Dr Fisher has given me an opportunity to discuss this in his letter of 12 April, but I wish to address this at a later date.

I would appreciate it if a meeting could be arranged as soon as possible and to that end I look forward to hearing from you by close of business on 1 August 2011.

Yours faithfully

Local Resolution Meeting held 12 September 2011...

The Trust's response (date 11 October 2011) post meeting date is as follows;

I am very sorry for the delay in responding but unfortunately the tape that I dictated my letter on went missing.

This is just to remind you that we discussed queries regarding how Dr Barnett's team reached a diagnosis. We had a discussion about diagnostic criteria as set forth by the World Health Organisation (WHO) and that we used the operationalised criteria as in the latest edition of the International Classification of Disease Chapter 5 which is the chapter for mental health. I gave an overview about how we reached diagnoses and that there are usually symptoms and signs as reported by you that would fulfil the criteria for the diagnosis reached.

I gave you a print-out about the relevant chapter on the International Classification of Disease for you and you were quite happy about that. Since that time Dr Barnett was on special leave and the SHO in your case is no longer working for us, we could not have any of them in person at the meeting to explain in more detail how the diagnoses was reached by them at that time. You made me aware of your concerns that there was a diagnosis of a paranoid schizophrenia in the GP notes which, in your view, predated the meetings with Dr Price's team at our surgery. Since the GPs have their own filing system and are not part of our Trust, I can not comment on that. You would need to go into your GP practice to discuss it yourself or ask the Primary Care Trust for City & Hackney if they would want to start an investigation for that. Since you are also no longer a patient of our CMHT I would suggest going with any further queries to your GP practice.

I hope this is helpful.

Consultant Psychiatrist Associate Clinical Director

I would like to know;

1. Are the above letters justified?

2. My GP made an entry of paranoid psychosis and delusional disorder in my medical records on 21 April 2010; although I was not diagnosed until 25 August 2010. Is this right?

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